ACES - ACE Inhibitors Combined With Exercise for Seniors With Hypertension

Prior treatment

• BP \> 140/90, despite the use of three or more anti-hypertensive drugs

Other illness

• Chronic kidney disease
• Severe cardiac disease, including NYHA Class III or IV congestive heart failure, clinically significant aortic stenosis, history of cardiac arrest, use of a cardiac defibrillator, or uncontrolled angina
• Acute myocardial infarction identified by ECG
• Significant cognitive impairment, defined as a known diagnosis of dementia or a Mini-Mental State Examination exam score \< 24;
• Known hypersensitivity to ACE inhibitors (exclusion only to perindopril arm; will be randomized among other two interventions)
• Any other condition that would preclude participating based upon judgement of PI or study clinician team

Lab values

• Serum creatinine \>2.5 mg/dL in men or \>2.0 mg/dL in women
• Serum potassium outside normal reference range
• Abnormal liver enzymes (AST, ALT, or alkaline phosphatase \> 2.5 times the upper limit of normal)

Other

• SBP \> 180 mm Hg or DBP \> 110 mm Hg
• Urinary protein \> 1 on dipstick
• Simultaneous participation in another intervention trial

• Age 60 years and older
• Hypertension - untreated (SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg) or treated
• \> 290 seconds needed to complete long-distance corridor walk test
• Sedentary lifestyle, defined as \<150 min/wk of moderate physical activity
• Willingness to participate in all study procedures, including allowing study team to communicate with primary care physician regarding changes in antihypertensive treatment